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Published on: February 9, 2016
Race differences in cardiac catheterization: the role of social contextual variables
Brian J Ayotte1, Nancy R Kressin
1Center for Organizational, Leadership, and Management Research, VA Boston Healthcare System, Boston, MA, USA. brian.ayotte@va.gov
Insights
Social context significantly influences cardiac catheterization rates, explaining racial disparities in recommended procedures. Knowing people who had the procedure and receiving encouragement increased likelihood, reducing race-based differences.
Area of Science:
- Cardiology
- Health Disparities Research
- Social Determinants of Health
Background:
- Race disparities in invasive cardiac procedures are documented but poorly understood.
- Etiology of these disparities requires further investigation.
Purpose of the Study:
- To examine the relationship between social contextual variables and race differences in cardiac catheterization likelihood.
- To investigate the role of social context in disparities among veterans recommended for the procedure.
Main Methods:
- Prospective observational cohort study.
- Subsample of Black/African American and White veterans recommended for cardiac catheterization.
- Assessed social contextual, clinical, and procedural data.
Main Results:
- Black/African Americans were less likely to undergo cardiac catheterization than Whites, even after controlling for clinical factors (OR=0.31).
- Knowing someone who had the procedure, social support, and family encouragement were linked to increased likelihood (ORs > 1.45).
- Social contextual variables attenuated the observed race disparities, suggesting their significant role.
Conclusions:
- Social contextual factors are associated with receiving recommended cardiac care.
- These factors help explain and reduce race disparities in cardiac catheterization rates among recommended patients.
Background:
Race differences in the receipt of invasive cardiac procedures are well-documented but the etiology remains poorly understood.
Objective:
We examined how social contextual variables were related to race differences in the likelihood of receiving cardiac catheterization in a sample of veterans who were recommended to undergo the procedure by a physician.
Design:
Prospective observational cohort study.
Participants:
A subsample from a study examining race disparities in cardiac catheterization of 48 Black/African American and 189 White veterans who were recommended by a physician to undergo cardiac catheterization.
Measures:
We assessed social contextual variables (e.g., knowing somebody who had the procedure, being encouraged by family or friends), clinical variables (e.g., hypertension, maximal medical therapy), and if participants received cardiac catheterization at any point during the study.
Key Results:
Blacks/African Americans were less likely to undergo cardiac catheterization compared to Whites even after controlling for age, education, and clinical variables (OR = 0.31; 95% CI, 0.13, 0.75). After controlling for demographic and clinical variables, three social contextual variables were significantly related to increased likelihood of receiving catheterization: knowing someone who had undergone the procedure (OR = 3.14; 95% CI, 1.70, 8.74), social support (OR = 2.05; 95% CI, 1.17, 2.78), and being encouraged by family to have procedure (OR = 1.45; 95% CI, 1.08, 1.90). After adding the social contextual variables, race was no longer significantly related to the likelihood of receiving catheterization, thus suggesting that social context plays an important role in the relationship between race and cardiac catheterization.
Conclusions:
Our results suggest that social contextual factors are related to the likelihood of receiving recommended care. In addition, accounting for these relationships attenuated the observed race disparities between Whites and Blacks/African Americans who were recommended to undergo cardiac catheterization by their physicians.
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